한국형 중독 치료지침서(II) : 알코올 금단의 약물 치료
Korean Addiction Treatment Guidelines Series (II): Pharmacological Treatment of Alcohol Withdrawal
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Objectives In development of Korean addiction treatment guidelines, the aim of this study was to investigate the experts’ consensus regarding current pharmacological practice in treatment of alcohol withdrawal. Methods Using recommendations from foreign clinical guidelines, which were either lacking in evidence or could not be directly applied to Korea, the executive committee developed a questionnaire consisting of 17 questions. Using a nine-point scale, members of the Korean Addiction Psychiatry, who were experts (n=150) with sufficient experience in treatment of alcohol use disorder,were asked to evaluate the appropriateness of each item on the questionnaire. We classified the experts’ opinion according to three categories, based on the lowest scores of 6.5 or greater as a first-line/preferred treatment, 3.5-6.5 as a second-line/reasonable treatment, and lower than 3.5as a third-line/inappropriate treatment. The consensus was determined by chi-square test (p<0.05). Response rate was 70.4% (81/115). Results The results of the survey from the experts were as follows: 1) Symptom triggered therapy (STT) was the most appropriate strategy in treatment of alcohol withdrawal (95% CI 7.41-8.04). 2) Prophylactic benzodiazepine was recommended for management of expecting alcohol withdrawal in out-patient-department patients. 3) Among benzodiazepines, lorazepam was the most preferred. 4) For patients with severe withdrawal, lorazepam 7.4 mg/day (95% CI 6.48-8.25, maximum dose=20 mg) was recommended. 5) Risperidone, quetiapine, and haloperidol were the first-line drugs for patients with alcohol withdrawal and combined psychotic symptoms. 6) 127.5 mg (95% CI 111-145) for 2.8 months of prophylactic thiamine and 213.5 mg (95% CI 190-240) for 6.2 months of thiamine for Wernicke-Korsakoff’s syndrome were recommended. Conclusion We hope that these Korean addiction treatment guidelines, added by the Korean experts’ consensus, will be helpful in promoting the efficacy of treatment for alcohol withdrawal.
Abstract
Objectives In development of Korean addiction treatment guidelines, the aim of this study was to investigate the experts’ consensus regarding current pharmacological practice in treatment of alcohol withdrawal. Methods Using recommendations from foreign clinical guidelines, which were either lacking in evidence or could not be directly applied to Korea, the executive committee developed a questionnaire consisting of 17 questions. Using a nine-point scale, members of the Korean Addiction Psychiatry, who were experts (n=150) with sufficient experience in treatment of alcohol use disorder,were asked to evaluate the appropriateness of each item on the questionnaire. We classified the experts’ opinion according to three categories, based on the lowest scores of 6.5 or greater as a first-line/preferred treatment, 3.5-6.5 as a second-line/reasonable treatment, and lower than 3.5as a third-line/inappropriate treatment. The consensus was determined by chi-square test (p<0.05). Response rate was 70.4% (81/115). Results The results of the survey from the experts were as follows: 1) Symptom triggered therapy (STT) was the most appropriate strategy in treatment of alcohol withdrawal (95% CI 7.41-8.04). 2) Prophylactic benzodiazepine was recommended for management of expecting alcohol withdrawal in out-patient-department patients. 3) Among benzodiazepines, lorazepam was the most preferred. 4) For patients with severe withdrawal, lorazepam 7.4 mg/day (95% CI 6.48-8.25, maximum dose=20 mg) was recommended. 5) Risperidone, quetiapine, and haloperidol were the first-line drugs for patients with alcohol withdrawal and combined psychotic symptoms. 6) 127.5 mg (95% CI 111-145) for 2.8 months of prophylactic thiamine and 213.5 mg (95% CI 190-240) for 6.2 months of thiamine for Wernicke-Korsakoff’s syndrome were recommended. Conclusion We hope that these Korean addiction treatment guidelines, added by the Korean experts’ consensus, will be helpful in promoting the efficacy of treatment for alcohol withdrawal.
참고문헌 (34)
- American Psychiatric Association, "Diagnostic and statistical manual of mental disorders" (2000), American Psychiatric Association
- Bayard M, "Alcohol withdrawal syndrome", Am Fam Physician, 69, pp.1443~1450 (2004)
- "Detoxification: principles and protocols"[URL]
- The Epidemiological Survey of Psychiatric Illnesses in Korea, "Seoul National University College of medicine", Ministry of Health & Welfare, 1~15 (2006)
- Addiction Treatment Guidelines Series, "Kim SG", Ministry of health & welfare alcohol project supporting committee, ~ (2011)
- University of Sydney, "Guidelines for the treatment of alcohol problems", University of Sydney, 1~255 (2009)
- Williams D, "The drug treatment of alcohol withdrawal symptoms: a systematic review", Alcohol Alcohol, 33, pp.103~115 (1998)
- Field MJ, "Guidelines for Clinical Practice: from Development to Use" (1992), National Academy Press
- "Clinical practice guideline for stroke"[URL]
- "Hypertension treatment guidelines, Depressive disorders treatment guidelines"[URL]
- Kim SY, "Manual for Guideline Adaptation ver 1.0", Korea Centers For Disease Control & Prevention, Clinical research coordinating center, Guidelines supporting center, 1~115 (2009)
- "Appraisal of Guidelines for Research & Evaluation"[URL]
- "Addiction Treatment Guidelines Series"[URL]
- Sachs GS, "The Expert Consensus Guideline Series: Medication Treatment of Bipolar Disorder 2000", Postgrad Med, pp.1~104 (2000)
- 서정석, "한국형 우울장애 약물치료 알고리듬 2006 (Ⅰ)", 신경정신의학, 46(5), pp.453~460 (2007), 대한신경정신의학회
- Lange-Asschenfeldt C, "Symptom-triggered versus standard chlormethiazole treatment of inpatient alcohol withdrawal: clinical implications from a chart analysis", Eur Addict Res, 9, pp.1~7 (2003)
- Daeppen JB, "Symptom-triggered vs fixed-schedule doses of benzodiazepine for alcohol withdrawal: a randomized treatment trial", Arch Intern Med, 162, pp.1117~1121 (2002)
- Hecksel KA, "Inappropriate use of symptom-triggered therapy for alcohol withdrawal in the general hospital", Mayo Clin Proc, 83, pp.274~279 (2008)
- Lohr RH, "Treatment of alcohol withdrawal in hospitalized patients", Mayo Clin Proc, 70, pp.777~782 (1995)
- Jaeger TM, "Symptom-triggered therapy for alcohol withdrawal syndrome in medical inpatients", Mayo Clin Proc, 76, pp.695~701 (2010)
- Elholm B, "Alcohol withdrawal syndrome: symptom-triggered versus fixed-schedule treatment in an outpatient setting", Alcohol Alcohol, 46, pp.318~323 (2011)
- Prater CD, "Outpatient detoxification of the addicted or alcoholic patient", Am Fam Physician, 60, pp.1175~1183 (1999)
- Myrick H, "Treatment of alcohol withdrawal", Alcohol Health Res World, 22, pp.38~43 (1998)
- Bayard M, "Alcohol withdrawal syndrome", Am Fam Physician, 69, pp.1443~1450 (2004)
- Mayo-Smith MF, "Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal", JAMA, 278, pp.144~151 (1997)
- Mayo-Smith MF, "Management of alcohol withdrawal delirium. An evidence- based practice guideline", Arch Intern Med, 164, pp.1405~1412 (2004)
- Lingford-Hughes AR, "British Association for Psychopharmacology. Evidence-based guidelines for the pharmacological management of substance misuse, addiction and comorbidity: recommendations from the British Association for Psychopharmacology", J Psychopharmacol, 18, pp.293~335 (2004)
- Sullivan JT, "Benzodiazepine requirements during alcohol withdrawal syndrome: clinical implications of using a standardized withdrawal scale", J Clin Psychopharmacol, 11, pp.291~295 (1991)
- Holbrook AM, "Diagnosis and management of acute alcohol withdrawal", CMAJ, 160, pp.675~680 (1999)
- Work Group on Substance Use Disorders, "Treatment of patients with substance use disorders, second edition. American Psychiatic Association", Am J Psychiatry, 163(8 Suppl), pp.5~82 (2006)
- National Clinical Guideline Centre, "Alcohol-Use Disorders: Diagnosis and Clinical Management of Alcohol-Related Physical Complications", NICE clinical guideline, 1~30 (2010)
- Day E, "Thiamine for Wernicke-Korsakoff Syndrome in people at risk from alcohol abuse", Cochrane Database Syst Rev, pp.CD004033~ (2004)
- Sechi G, "Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management", Lancet Neurol, 6, pp.442~455 (2007)
- 이서정, "일 대학병원에 입원하는 알코올 의존 환자에서 동반되는 베르니케 뇌병증의 선별 및 치료", 신경정신의학, 50(4), pp.323~328 (2011), 대한신경정신의학회